Colorectal cancer
happens when cells that are not normal grow in your
colon or rectum. These cells grow together and form tumors. This cancer is also
called colon cancer or rectal cancer.
Colon and rectal cancers
often return months or years after treatment. This is called recurrent cancer.
If the original cancer was removed before it was able to spread, the chances
that it will return are lower.
Metastatic cancer is cancer that
has spread to other parts of the body. When colon or rectal cancer spreads, it
most often spreads to the liver. Sometimes it spreads to the lungs, bones, or
brain.
What causes metastatic or recurrent colorectal cancer?
The exact cause is not known, but the cancer is more likely to come back
or spread if it is in a later, more advanced stage when it is first
discovered.
What are the symptoms?
Some people do not have any
symptoms. When they do occur, the most common symptoms are:
Belly pain, especially gas pains, cramps, or
a feeling of fullness.
Blood in your stool or very dark stools.
A change in your bowel habits, such as more frequent stools,
thinner stools, or a feeling that your bowels are not emptying completely.
If your cancer has spread, you may have other symptoms,
depending on where the cancer is. If it has spread to:
The lymph nodesof
your belly, it may cause bloating, a swollen belly, loss of appetite, or a
feeling of fullness.
The liver, it may
cause pain on the upper right side of your belly, bloating, loss of appetite,
or a feeling of fullness.
The lungs, it
may cause you to cough, spit up blood, or have a hard time breathing.
The bones, it may cause bone pain,
especially in your back, hips, and pelvis.
The brain, it may cause problems with memory, concentration, balance, or
movement.
How is metastatic or recurrent colorectal cancer diagnosed?
Colon or rectal cancer that has returned or spread is
diagnosed using a physical exam and several tests, including blood tests, chest
X-rays,
bone scans,
ultrasounds, and
CT,
PET, or
MRI scans.
The diagnosis is usually
confirmed with a
biopsy. During this test, your doctor will take tissue
samples from any areas that don't look normal. The tissue will be looked at
under a microscope to see if it contains cancer.
If you have been
treated for colon or rectal cancer in the past, it's important to have regular
checkups to find any new cancer as soon as possible.
How is it treated?
Some colon and rectal cancers
that have returned or spread can still be cured. Treatment may include surgery,
radiation, and chemotherapy. When the cancer cannot be cured, treatment can
help you feel better and live longer.
Learning that you have
cancer can be upsetting. It may help to talk with your doctor or with other
people who have had cancer. Your local American Cancer Society chapter can help
you find a support group.
Frequently Asked Questions
Learning about metastatic and recurrent colorectal cancer:
If your cancer has spread, you may have other symptoms,
depending on where the cancer is. If it has spread to:
The lymph nodes of your
abdomen, it may cause bloating, a swollen belly, loss of appetite, or a feeling
of fullness.
The liver, it may cause pain on
the upper right side of your abdomen, bloating, loss of appetite, or a feeling
of fullness.
The lungs, it may cause
coughing, spitting up blood, or a hard time breathing.
The bones, it may cause bone pain, especially in the back,
hips, and pelvis.
The brain, it may cause
problems with memory, concentration, balance, or movement.
What Happens
Cancer is the growth of abnormal cells in
the body. These extra cells grow together and form masses, lumps, or tumors. In
colorectal cancer, these growths usually start as
harmless (benign) polyps in the
large intestine (colon or rectum).
Colon polyps are common and most do not cause
problems. But if polyps are not detected and removed, some of them can turn
into cancer.
If the cancer is allowed to continue growing, it
eventually will invade and destroy nearby tissues and then spread farther.
Colorectal cancer spreads first to nearby lymph nodes. From there it may spread
to other parts of the body, usually to the liver. It may also spread to the
lungs, bones, or brain.
Metastatic or recurrent colorectal cancer occurs when cancer cells travel, through
either the bloodstream or the
lymph system, to other parts of the body and continue
to grow in their new location. Recurrent colorectal cancer occurs when the
cancer begins to grow again months or years after treatment.
How
colorectal cancer will affect your life span depends on the
stage of your cancer. A cancer's stage depends on how
far it has spread.
The 5-year survival rate for cancer that has
spread to other parts of the body is 10%.1 The 5-year
survival rate is the percentage of people who are still alive 5 years or longer
after their cancer was discovered. It is important to remember that this is
only an average. Everyone is different, and these numbers do not necessarily
show what will happen to you.
What Increases Your Risk
Even after successful
treatment, colorectal cancer comes back (recurs) about half the time.2 But this depends on the stage of the cancer before treatment.
For example, if colorectal cancer is removed while it is still contained within
the colon and has not spread, your risk of developing
metastatic or recurrent colorectal cancer is
less.
When To Call a Doctor
Some people who have
metastatic or recurrent colorectal cancer do not have
any symptoms. Sometimes it is discovered before symptoms appear, either on a
chest X-ray or as part of lab tests.
You may be seeing a doctor
regularly to check for symptoms, but symptoms might start between visits. Be
aware of what is normal for you, and tell your doctor about any changes right
away. Be sure to let your doctor know if you feel even very small
changes.
What symptoms you may have will depend on which part of
your body is affected by the cancer. Call your doctor if you have any of these
symptoms:
A change in bowel habits, such as bleeding from
your rectum, bright red or dark blood in your stools, frequent diarrhea,
constipation, a feeling that your bowel is not emptying completely, or stools
that are narrow (may be no wider than a pencil)
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without giving
treatment to cure your cancer. Watchful waiting may be an option if treatment
may cause more harm than good and is unlikely to cure your cancer. Remember,
though, that watchful waiting does not mean your doctor won't treat your
symptoms, such as pain.
Who To See
If you have been treated for colorectal cancer,
doctors who can evaluate any new symptoms include:
A
colonoscopy to see if cancer has returned to your
intestine.
Blood tests to find out if cancer has returned (CEA) or to find the cause of symptoms such as
weakness, fatigue, fever, bruising, or weight loss (complete blood count and
blood profile).
A
chest X-ray to find the cause of symptoms such as
persistent coughing, coughing up blood, chest pain, or difficult
breathing.
A
CT scan,
MRI, or
PET scan to see if colorectal cancer has spread into
the chest or organs in the abdomen or pelvis.
A brain CT scan or
MRI to look into symptoms such as confusion, paralysis, numbness, vision
problems, vertigo, or headaches.
A biopsy, such as a
liver biopsy or a
lung biopsy, to find out where the cancer cells have
spread.
A
bone scan to find out whether cancer cells have spread
to the bones.
What to think about
Colorectal cancer often comes
back, even after successful treatment. If you had colorectal cancer in the
past, pay close attention to your body and see your doctor regularly. Tell your
doctor about any changes, such as decreased appetite, bloating, or an increase
in the size of your belly.
Your cancer may return even if you do
everything you can to prevent it. If this happens, focus on what you and your
doctor can do to treat your symptoms to help you feel better and live
longer.
Some cases of metastatic or recurrent colorectal cancer
can still be cured. When it cannot be cured, treatment can help you feel better
and live longer.
Your treatment may include:
Surgery. If your cancer
has come back in your intestine, surgery may be used to remove it. If it has
spread to other parts of the body, it can sometimes be treated surgically.
Cancer that has spread to the liver is sometimes successfully removed with
surgery. For more information, see the Surgery section of this
topic.
Drugs. The use of drugs, either
swallowed or injected with a needle, to treat cancer is called
chemotherapy. Drugs can help you live longer by
killing cancer cells that have spread to other parts of your body. They also
can relieve pain caused by the cancer. For more information, see the
Medications section of this topic.
Radiation therapy. X-rays can be used to shrink colorectal tumors that may be
causing blockages. They can also reduce bleeding or pain. For more information,
see the Other Treatment section of this topic.
Clinical trials.Clinical trials are studies of new or different ways
to treat cancer.
Home treatment.There are
things you can do at home to manage the side effects caused by cancer and its
treatments. For more information, see the Home Treatment section of this
topic.
Dealing with your emotions
If you have been told you have metastatic or recurrent colorectal cancer,
you may have many different feelings. Most people feel some denial, anger, and
grief. There is no "normal" or "right" way to react. But there are things you
can do to help manage your
emotional reaction.
You may find that
talking with family and friends helps. Some people find that spending time
alone is what they need. You may also contact your local chapter of the
American Cancer Society to find a support group. Talking with other people who
have had similar experiences can be very helpful.
If your
reaction is interfering with your ability to make decisions, it is important to
talk with your doctor. Your cancer treatment center may offer counseling
services.
Palliative care
As your cancer gets worse, you may
want to think about
palliative care. Palliative care is a kind of care for
people who have illnesses that do not go away and often get worse over time. It
is different than care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life-not just in your
body, but also in your mind and spirit. Some people combine palliative care
with curative care.
Palliative care may help you manage symptoms
or side effects from treatment. It could also help you cope with your feelings
about living with a long-term illness, make future plans around your medical
care, or help your family better understand your illness and how to support
you.
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
The 5-year survival rate for
colorectal cancer that has spread to other parts of the body is 10%.1 This means that 5 years after their cancer was discovered, 1
out of 10 people are still living. It is important to remember that this is
only an average. Everyone is different, and these numbers do not necessarily
show what will happen to you.
You may wish to discuss health care
and other legal issues that arise near the end of life with your family and
your doctor. You may find it helpful and comforting to state your health care
choices in writing (with an advance directive or living will) while you are
still able to make and communicate these decisions. Think about your treatment
options and which kind of treatment will be best for you. You may wish to
choose a health care agent in case you become unable to speak for
yourself.
A time may come when your goals or the goals of your
loved ones may change from treating your illness to maintaining your comfort
and dignity. You may choose
hospice care. Hospice caregivers are concerned with
enhancing the quality of your remaining life by keeping you as alert and
comfortable as possible in a familiar environment with family and friends.
Hospice programs offer services in your own home or in a hospice center,
nursing home, or hospital.
Learning all you can about end-of-life
issues may help you feel better. For more information, see one of the following
topics:
There is no sure way to prevent
colorectal cancer from returning or showing up in
other parts of your body. After you have had it, your risk of having it again
increases. When it comes back, it is called
metastatic or recurrent colorectal cancer. It often
comes back after surgery, especially if it was not discovered when it was in an
early stage.2 This does not mean it will come back in
your case. Everyone is different.
Initial treatment for colorectal
cancer is followed by regular doctor visits and screening to help catch the
cancer if it returns.
As part of your follow-up visits, you may
have:
Physical exams. The frequency of your physical exams
depends on your general health and the type of colorectal cancer you had. In
general, you will see a doctor every 3 to 6 months for 3 years, and then once a
year after that.
Colonoscopy to look at the inside of
your intestine for new problems.
Home treatment may be all that is needed
to help manage the side effects that often accompany
metastatic or recurrent colon cancer or its treatment.
Healthy habits such as eating a balanced diet and getting enough sleep and
exercise may help control your symptoms. Be sure to follow any instructions
your doctor has given you.
Home treatment for nausea or vomiting
includes watching for and treating early signs of
dehydration, such as a dry mouth, sticky saliva,
having smaller than usual amounts of urine, or having urine that is dark
yellow. Your doctor also may prescribe
medicines to control nausea and vomiting. For more
information on how to deal with these side effects, see:
Home treatment for pain can range from
cold packs and over-the-counter drugs and to massage and meditation. For more
information, see the topic
Cancer Pain.
Home treatment for diarrhea includes resting your stomach by not eating for several hours
or until you feel better, and watching for signs of dehydration. Check with
your doctor before using any drugs for your diarrhea.
Home treatment for constipation includes getting gentle exercise, drinking
plenty of fluids, and eating lots of fruits, vegetables, and foods that contain
fiber. Check with your doctor before using a laxative.
Treatment for fatigue includes getting extra rest while you are having chemotherapy or
radiation therapy. Let your symptoms be your guide. You may be able to keep
your usual routine and just get some extra sleep. Fatigue is often worse at the
end of treatment or just after treatment is over. If you find you have trouble
sleeping, some
tips to relieve sleep problems may be helpful.
Managing your emotions
Learning that you have colorectal cancer and being treated for it can be
very stressful.
If your emotions interfere with your ability to
make decisions, it is important to talk to your doctor about them. Your cancer
treatment center may offer counseling services, support groups, and classes
such as yoga. You may be able to
reduce your stress by expressing your feelings to
others. Learning relaxation techniques may also help you reduce your stress.
Some people find that spending time alone is what they need.
Your
feelings about your body may change after treatment.
Dealing with your body image may involve talking
openly about your worries with your partner and discussing your feelings with a
doctor.
Contact your local chapter of the American Cancer Society
to find a support group. Talking with other people who have had similar
experiences can be very helpful.
Medications
Chemotherapy is the use of drugs to control
cancer's growth or relieve symptoms. Often the drugs are given through a needle
in your vein, and your blood vessels carry the drugs through your body.
Sometimes the drugs are available as pills you can swallow. Sometimes they are
given through a shot, or injection. For colorectal cancer that has spread to
the liver, researchers are studying hepatic intra-arterial chemotherapy. This
delivers drugs directly to the liver.
Cancer drugs are often used in combination. For example,
a treatment called FOLFOX4 uses oxaliplatin, leucovorin, and fluorouracil,
while the treatment called FOLFIRI uses folic acid, fluorouracil, and
irinotecan. There are several of these specific drug combinations.
Cetuximab (Erbitux) and panitumumab (Vectibix) may be
used for colorectal cancer that has spread and has not gotten better during or
after treatment with other drugs. These kinds of medicines, called
monoclonal antibodies, may not work for some people.
So before you have this treatment, your tumor tissue will be checked for
certain gene changes (mutations).
Phenothiazines, such as promethazine and
prochlorperazine.
Serotonin antagonists, such as ondansetron (Zofran),
granisetron (Kytril), or dolasetron (Anzemet). These medicines prevent nausea
and vomiting caused by chemotherapy more effectively when they are combined
with corticosteroids, such as dexamethasone.
Clinical trials that test new drugs are ongoing. Talk
with your doctor about participating in a clinical trial.
What To Think About
Drugs may not cure metastatic or
recurrent colorectal cancer, but they can help you feel better and live longer
by slowing the cancer's growth.
Talk to your doctor about drugs to
help you
manage pain and other symptoms that may accompany
cancer. For more information, see the topic
Cancer Pain.
Bowel resection. This operation
involves cutting into the abdomen to reach the area of the colon or rectum that
is affected by the cancer. The surgeon cuts out the cancer as well as the parts
of the colon or rectum that are next to it. Then the two healthy ends of the
colon or rectum are sewn back together.
Liver resection. In this operation the surgeon cuts
out cancer that has spread to the liver, as well as parts of the liver that are
next to the cancer. Up to half of your liver can be removed as long as the rest
is healthy. Two other methods to destroy cancer cells in the liver include
radio waves (radiofrequency ablation) and heat (microwave
coagulation).
Cryosurgery. Also called cryotherapy, this type of
surgery uses liquid nitrogen to freeze and destroy colorectal cancer that has
spread to the liver. It is used when the tumors in the liver are still fairly
small.
If cancer that has returned to your intestine is large,
more of your colon or rectum may have to be removed. The ends of your colon or
rectum are rejoined during surgery. If they can't be rejoined, you may need a
colostomy. Most people do not need a permanent
colostomy.
When cancer has spread to other parts of the body, the
kind of surgery you will need depends on where the cancer is and how big the
tumor is. Sometimes surgery is used not to cure your cancer but to make your
life more comfortable. If a tumor is blocking your colon, for example, the
surgeon may remove it to allow your intestine to work normally. If advanced
cancer is blocking your rectum, your doctor may place an expandable tube,
called a stent, in the rectum to unblock it.
What To Think About
Surgery may be used to remove
metastatic or recurrent colorectal cancer that is confined to the colon or that
has spread to the liver, lungs, or bones. Surgery does not usually cure
metastatic or recurrent colorectal cancer, but it may relieve pain and
discomfort, slow the spread of the disease, and help you live longer.
Other Treatment
Radiation treatment
Radiation therapy uses X-rays to destroy
colorectal cancer cells. It is often combined with
surgery or chemotherapy. Radiation therapy may also be used to reduce the
cancer's size when it is blocking the colon or rectum or to relieve pain from
cancer that has spread to other organs.
Radiation treatments are
not likely to cure
metastatic or recurrent colorectal cancer, but they
may ease pain and discomfort, slow the spread of the disease, and help you live
longer.
Treatment for liver cancer
Sometimes colorectal cancer that has spread to the liver can be removed
by surgery. But usually other treatments are necessary, such as:
Radiofrequency ablation. A small wire that emits radio waves is inserted into the
tumor. The radio waves destroy the liver tumor without harming healthy
tissue.
Cryosurgery. This is often done in
surgery for liver cancer but sometimes can be done through the skin
(percutaneous). When cryosurgery is done through the skin, the doctor uses
ultrasound or
magnetic resonance imaging (MRI) to guide probes that
deliver liquid nitrogen directly to the tumor in the liver. The liquid nitrogen
freezes and destroys cancer cells.
Embolization. Tumor embolization shrinks a liver tumor by
cutting off its blood supply. Guided by ultrasound or MRI, the doctor puts a
thin, flexible tube, called a catheter, into an artery near your groin or in
your arm. The catheter is guided into the liver artery (the hepatic artery)
that supplies blood to the tumor. A mixture of chemicals and small particles
(like grains of sand) are sent through the catheter into the hepatic artery.
This mixture blocks the artery and stops blood from getting to the liver
tumor.
Interstitial radiation therapy. In
this type of internal radiation therapy, radioactive material sealed in
needles, wires, seeds, or catheters is placed directly into the tumor or body
tissue.
Intra-arterial hepatic chemotherapy. The surgeon implants a small pump in the belly that
delivers chemotherapy right into the tumor. The pump can be left in place as
long as needed.
Complementary therapies
In addition to conventional medical treatment, complementary therapies
may improve the quality of your life by helping you manage the stress and side
effects of cancer treatment. But these complementary therapies should not
replace standard therapy.
Before you try any of these therapies, discuss their
possible benefits and side effects with your doctor. Let him or her know if you
are already using any such therapies. For more information, see the topic
Complementary Medicine.
What to think about
Clinical trials are
studies designed to find better ways to treat people and are based on the most
up-to-date information. There are a number of clinical trials involving the
treatment for metastatic or advanced colorectal cancer. If you match the
guidelines, you may be able to enroll in one. If you are interested, ask your
doctor whether there are trials in which you can participate. The National
Cancer Institute or your local chapter of the American Cancer Society can also
help you find clinical trials.
Other Places To Get Help
Organizations
American College of
Gastroenterology
P.O. Box 342260
Bethesda, MD 20827-2260
Phone:
(301) 263-9000
Web Address:
www.acg.gi.org
The American College of Gastroenterology is an organization of
digestive disease specialists. The Web site contains information about common
gastrointestinal problems.
American Cancer Society
Phone:
1-800-ACS-2345 (1-800-227-2345)
TDD:
1-866-228-4327 (toll-free)
Web Address:
www.cancer.org
The American Cancer Society conducts educational programs and
offers many services to people with cancer and to their families. Staff at the
toll-free numbers have information about services and activities in local areas
and can provide referrals to local ACS divisions.
American Society of Clinical Oncology
(ASCO)
1900 Duke Street
Suite 200
Alexandria, VA 22314
Phone:
(703) 299-0150
Fax:
(703) 299-1044
TDD:
1-888-651-3038
E-mail:
asco@asco.org
Web Address:
http://www.asco.org
This organization offers information and educational programs on
cancer.
Cancer.Net
Phone:
1-888-651-3036 (571) 483-1300
Fax:
(571) 366-9530
E-mail:
foundation@asco.org
Web Address:
www.cancer.net
Cancer.Net is the information Web site of the American
Society of Clinical Oncology (ASCO) for people living with cancer and for those
who care for them. ASCO is the world's leading professional organization
representing physicians of all oncology subspecialties. Cancer.Net provides
current oncologist-approved information on living with cancer.
National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD 20892-8322
Phone:
1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:
1-800-332-8615
E-mail:
cancergovstaff@mail.nih.gov
Web Address:
www.cancer.gov (or
https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help
online)
The National Cancer Institute (NCI) is a U.S. government agency
that provides up-to-date information about the prevention, detection, and
treatment of cancer. NCI also offers supportive care to people with cancer and
to their families. NCI information is also available to doctors, nurses, and
other health professionals. NCI provides the latest information about clinical
trials. The Cancer Information Service, a service of NCI, has trained staff
members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
National Institutes of Health: Health
Information
9000 Rockville Pike
Bethesda, MD 20892
Phone:
(301) 496-4000
TDD:
(301) 402-9612
E-mail:
NIHinfo@od.nih.gov
Web Address:
http://health.nih.gov
The U.S. National Institutes of Health (NIH) conducts
and supports medical research to improve people's health and save lives. NIH
provides access to health and wellness information, free newsletters, current
research, health databases, fact sheets, and many other resources.
American Cancer Society (2005). Colorectal Cancer Facts and Figures: Special Edition 2005, pp.
1-20. Available online:
http://www.cancer.org/docroot/STT/content/STT_1x_Colorectal_Cancer_Facts_and_Figures_-_Special_Edition_2005.asp.
Lewis C (2007). Colorectal cancer screening, search
date November 2006. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Other Works Consulted
Levin B (2006). Colorectal cancer. In DC Dale, DD
Federman, eds., ACP Medicine, section 12, chap. 5. New
York: WebMD.
Libutti SK, et al. (2005). Cancer of the colon. In VT
DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1061-1109. Philadelphia: Lippincott Williams and
Wilkins.
Libutti SK, et al. (2005). Cancer of the rectum. In VT
DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1110-1124. Philadelphia: Lippincott Williams and
Wilkins.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
American Cancer Society (2005). Colorectal Cancer Facts and Figures: Special Edition 2005, pp.
1-20. Available online:
http://www.cancer.org/docroot/STT/content/STT_1x_Colorectal_Cancer_Facts_and_Figures_-_Special_Edition_2005.asp.
Lewis C (2007). Colorectal cancer screening, search
date November 2006. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
